Combining regression trees and panel regression for exploring and testing the impact of complementary management practices on short-notice elective operation cancellation rates.
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ABSTRACT:
SUBMITTER: Salehnejad R
PROVIDER: S-EPMC7738292 | biostudies-literature | 2019 Apr
REPOSITORIES: biostudies-literature
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Combining regression trees and panel regression for exploring and testing the impact of complementary management practices on short-notice elective operation cancellation rates.
Salehnejad Reza R Ali Manhal M Proudlove Nathan N
Health systems (Basingstoke, England) 20190419 4
Variation in the performance of providers across healthcare systems is pervasive. It is recognised as both a major concern and an opportunity for learning and improvement. Variation between providers is broadly considered to be due to management practices and contextual factors such as catchment-area demographics. However, there is little understanding of the ways in which these impact on performance and how they can be measured. We use recent developments in both regression trees and panel regr ...[more]
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Project description:BackgroundCancellation of elective surgical operation recognized as a major cause of emotional trauma to patients as well as their families. In Ethiopia, prevalence and root causes for elective surgical case cancellation varies from time to time in different settings. This systematic review and meta-analysis aimed to find the pooled prevalence and root causes for elective surgical case cancellation in Ethiopia.MethodsThe databases for the search were Web of Science, PubMed, and Google Scholar. The last literature search was performed on February 8, 2020. To assess publication bias Egger's regression analysis was applied. The pooled estimation was estimated using random-effects model meta-analysis. Subgroup analysis was also done based on the root causes of surgical case cancellation.ResultsThis meta-analysis included a total of 5 studies with 5591 study participants. The pooled prevalence of elective surgical case cancellation was 21.41% (95% CI: 12.75 to 30.06%). Administration-related reason (34.50%) was the most common identified root cause, followed by surgeon (25.29%), medical (13.90%), and patient-related reasons (13.34%).ConclusionThe prevalence of elective surgical case cancellation was considerable. The most common root cause for elective surgical case cancellation was administration-related reasons, followed by the surgeon, medical and patient-related reasons. The causes for the surgical cancellations are potentially preventable. Thus, efforts should be made to prevent unnecessary cancellations through careful planning.
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Project description:PurposeHealth care systems in most European countries were temporarily restructured to provide as much capacity as possible for the treatment of coronavirus disease 2019 (COVID-19) patients. Subsequently, all elective surgeries had to be cancelled and postponed for months. The aim of the present study was to assess the pretreatment health status before and after COVID-19-related cancellation and the psychosocial distress caused by the cancellation.MethodsFor this study, a questionnaire was developed collecting sociodemographic data and information on health status before and after the cancellation. To assess psychosocial distress, the validated depression module of the Patient Health Questionnaire (PHQ-9), was implemented. PHQ-9-Scores of 10 and above were considered to indicate moderate or severe depressive symptoms. In total, 119 patients whose elective orthopaedic surgery was postponed due to the COVID-19 pandemic were surveyed once at least 8 weeks after the cancellation.ResultsSeventy-seven patients (65%; 34 female, 43 male) completed the questionnaire and were included. The predominant procedures were total knee arthroplasty (TKA), hip arthroscopy and foot and ankle surgery. The mean pain level significantly increased from 5.5 ± 2.2 at the time of the initially scheduled surgery to 6.2 ± 2.5 at the time of the survey (p < 0.0001). The pain level before cancellation of the surgery was significantly higher in female patients (p = 0.029). An increased analgetic consumption was identified in 46% of all patients. A mean PHQ-9 score of 6.1 ± 4.9 was found after cancellation. PHQ-9 scores of 10 or above were found in 14% of patients, and 8% exhibited scores of 15 points or above. Significantly higher PHQ-9 scores were seen in female patients (p = 0.046). No significant differences in PHQ-9 scores were found among age groups, procedures or reasons for cancellation.ConclusionCancellation of elective orthopaedic surgery resulted in pain levels that were significantly higher than when the surgery was scheduled, leading to increased analgesic use. Additionally, significant psychosocial distress due to the cancellation was identified in some patients, particularly middle-aged women. Despite these results, confidence in the national health care system and in the treating orthopaedic surgeons was not affected.Level of evidenceLevel III.
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Project description:Canceling elective surgical procedures is quite common throughout Ethiopia. Despite this, there is limited evidence about the time to elective surgery after cancellation in the country. Thus, the current study aimed to determine the time to elective surgery and its predictors after the first cancellation. An institution-based retrospective follow-up study was conducted on 386 study participants at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia, between September 1, 2017, and August 31, 2022. Utilizing a checklist, data were retrieved. To choose study participants, systematic random sampling was employed. Epi-Data version 3.1 and STATA version 14.1 were utilized. Kaplan-Meier curves and log-rank tests were employed. The Cox proportional hazard model was fitted. The mean age of the participants was 41.01 + 18.61 years. Females made up 51% of the patients. The majority were illiterate (72.3%) and resided in rural areas (70.5%). Surgery following the first cancellation had a cumulative incidence of 83.6% (95% CI: 79.6, 87.05) and an incidence rate of 32.3 per 1,000 person-days (95% CI: 29.3, 35.5). The median survival time to surgery was 25 (IQR: 17-40) days. Urban residence (AHR = 1.62; 95% CI: 1.26-1.96), being a member of health insurance schemes (AHR = 1.55; 95% CI: 1.24-1.96), stable other medical conditions (AHR = 1.43; 95% CI: 1.13-1.79), and timely completion of diagnostic tests (AHR = 1.62; 95% CI: 1.29-2.04) were significant predictors of time to surgery after first cancellation. Our study revealed that the time to surgery after the first cancellation was in the globally acceptable range and met the national target. Clinicians should focus on timely completion of diagnostic or laboratory tests, facilitating health insurance coverage, and comprehensive assessment and treatment of any coexisting medical conditions. It is urged to stratify each department's time for surgery, taking into consideration of important variables.
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